The right-to-die - a test for overall freedom?

The right-to-die is one of the most emotive of subjects. Almost everyone has an opinion, but it is not a simple matter.

Last year Tony Nicklinson fought a battle with the High Court to allow a doctor to legally help him end his life. He was 58-years-old and had 'locked-in' syndrome after a stroke in 2005. The case was lost and Mr Nicklinson died days later. Paul Lamb, paralysed and in pain after a car accident in 1990, has 'taken up the fight' and his appeal is heard this week.

This is one of the most emotive of subjects. Almost everyone has an opinion, but it is not a simple matter. The definition of right-to-die is that a person with a terminal illness should be allowed to commit suicide, assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering. The right-to-die is sometimes associated with the idea that your body and your life are your own, to dispose of as you see fit.

Pilpel and Amsel write: "Contemporary proponents of 'rational suicide' or the 'right to die' usually demand by 'rationality' that the decision to kill oneself be both the autonomous choice of the agent (i.e. not due to anyone pressuring them to 'do the right thing' and commit suicide) and a 'best option under the circumstances' choice, as well as other natural conditions such as the choice being stable, not an impulsive decision, not due to mental illness and reached after due deliberation, etc."

Part of the question is whether the right-to-die is universal, only applies under certain circumstances, or if it exists at all. Some argue that all competent people have a right to end their own lives. Appel suggested that the right-to die is a test for the overall freedom of any given society.

There is no guiding consensus from religion; Hinduism accepts the right-to-die for those who are tormented by terminal illness and allows death through the non-violent practice of fasting to the point of starvation (prayopavesa). In contrast the Catholic faith views the act of ending one's life a grave sin - 'Thou shalt not kill.' There is also lack of consensus in differing countries; one American state, Montana, has found that the right-to-die applies to those with life-threatening medical conditions. However the Dutch have legalized voluntary euthanasia - one of the few countries in the world to have done so. Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions and in considerable pain.

In the UK, strong voices exist for and against, although the latest opinion conducted by patient.info opinion poll on this topic suggests that 81% of 'the man on the street' would vote for the legalisation of assisted suicide. Many of those against, fear legislation could never be robust enough to protect the most vulnerable.

Medical professionals appear equally split. Clare Gerada called for a 'position of neutrality' from Royal Colleges, arguing that "No particular group within [society] should have a disproportionate influence on this decision; in particular medical bodies should not impose the beliefs of some of their members on to patients and carers and oppose (or indeed support) a law on assisted dying."

Perhaps medics struggle with the concept of ending a life being the best possible option. Ever hopeful of a better way, we cling to the ancient primum non nocere, a phrase mirrored in Hippocrates work. However this was over 2,000 years ago, when most folk were lucky to make 50 years old. The concept of degenerative disease, that robs people of their dignity and quality of life for years, is an alien one.

Where the right-to-die is a test for the overall freedom of any given society, how much freedom do we want and are we responsible enough to handle it?